Infertility is More than Just Medicine: When Should Counseling be Considered?

David Smotrich, M.D. and Michael R. Mantell, Ph.D.
Smotrich Center for Reproductive Enhancement
San Diego, CA

According to the American Society of Reproductive Medicine, infertility is a disease of the reproductive system that impairs the body's ability to perform the basic function of reproduction. This disease affects about 6.1 million people in America, which is approximately about ten percent of the reproductive age population. Men and women are affected about equally.

Having a baby is a naturally complicated process. It depends on many factors. Healthy sperm, healthy eggs, fallopian tubes which allow sperm to travel to the egg, sperm which can fertilize the egg, the ability of the fertilized egg ( the embryo ) to implant in the woman's uterus, and a quality embryo are only some of the factors that are necessary to produce a healthy baby.

About one-third of the time infertility is attributed to male factors and about one-third of the time it is attributed to female factors. For another third of couples, there is a combination of male and female factors that cause infertility. Nearly 20% of couples who undergo a complete medical and psychological evaluation for infertility are diagnosed with unexplained infertility. No specific cause can be found.

Although there is little room for anyone today to doubt the very significant role that emotions play in infertility, there exits very little evidence that stress or anxiety causes infertility. Infertility is, however, a very stressful experience.

Many couples we see wonder whether weight and exercise can be causative factors in infertily. Low weight or significant weight loss can cause hormone imbalance and affect the development of eggs in the ovaries and sperm in the testes. Obesity can also alter normal hormone levels and affect egg development. Extreme exercise can lead to reduced sperm production and cessation of ovulation in women.

While many factors can lead to infertility, fortunately medical science has provided us with many medical treatments including pharmaceuticals and surgery. These are well known and widely accepted. In vitro fertilization, a treatment of choice for women with blocked, severely damaged or absent fallopian tubes, endometriosis or male factor infertility, is actually used in less than 5% of cases.

With infertility being one of the most distressing of all life crises that a couple can experience, psychological treatment is also a significant and essential element in a comprehensive treatment program. The infertile couple should turn to psychological assistance when significant mood swings occur over a prolonged period of time, when depression develops and won't go away, when your relationships are strained or your sleep and appetite are altered, when you can't concentrate or you feel high levels of anxiety, when you feel bitter, guilty, worthless or angry. Other instances that may require seeking professional help include, couples considering involvement in third party reproduction, increased use of alcohol or drugs, thoughts about suicide or death.

Many couples no longer feel in control of their lives, bodies or sex life when they are diagnosed with infertility. For many, the most important life goal, having a family, is severely threatened. There is physical, emotional, financial, and family tension. Making decisions about treatment paths, deciding between alternative treatments, exploring other family building options, considering surrogacy and gamete donation or giving up on family building altogether for awhile, carry with them additional emotional burden.

An intimate connection exists between the mind and the body, particularly in the field of reproductive medicine. Therefore, detailed assessment and comprehensive counseling tailored to the developmental phase of infertility and reproductive dysfunction are should be offered. These phases include acknowledgment, diagnosis, treatment and resolution.

The first step of the evaluation component of psychological assistance may consist of a clinical interview and psychological assessment. Psychological tests may be done to better assess the specific problem(s).

Couples going through infertility treatment are strongly advised to maximize their psychological health and enhance their reproductive potential by attending individual/couple counseling designed to teach specific coping skills. These skills may include stress management, strengthening the couple's bond, improving communication, learning highly effective and natural relaxation methods, improving parent-child relationship skills in cases of secondary infertility, developing helpful assertive communication with health-care professionals, and coping with the emotional roller coaster of infertility treatment. Special attention is given to the needs of diverse populations.

Counseling aims at defusing the tension associated with feelings of anger, guilt, blame, shame and loss of control. The helpless feelings many experience, together with growing self-doubt, anxiety, and threatened sexuality all contribute to a couple's anguish and distress. Psychological assistance targets these concerns and reduces their impact on fertility.

Specific topics of discussion may also include the emotional side effects of medication, anxiety about cancelled cycles, the stress of producing semen samples, coping with the wait for test results, depression over failed cycles, and miscarriage and ectopic pregnancy. Psychological stress regarding decisions about choosing surrogacy, egg donation and/or adoption as viable options may also be discussed in counseling.

Infertility is more than just medicine. While patients are sometimes resistant to facing it, a qualified psychologist can help you sort out your feelings, help you strengthen yourself and your problem solving skills, and help you communicate more effectively. Instead of a debilitating life crisis, with proper emotional support, infertility can provide you with an opportunity for long-lasting personal growth and a strengthened marital bond.

Smotrich Center for Reproductive Enhancement
6699 Alvarado Road, Suite 2306 San Diego, CA 92120